分散式侷限誘發療法對中風患者之軀幹控制、日常功能、生活品質之效益

Effects of Distributed Constraint-induced Therapy on Trunk Control, Daily Function, and Quality of Life in Patients with Chronic Stroke

陳怡安(Yi-An Chen) ； 林克忠(Keh-Chung Lin) ； 吳菁宜(Ching-Yi Wu) ； 林瀛洲(Yin-Chou Lin) ； 朱岳喬(Ngok-Kiu Chu) ； 柯智裕(Jyh-Yuh Ke) ； 吳佩璇(Pei-Hsuan Wu)

《台灣復健醫學雜誌》 38卷2期 (2010/06) Pp. 75-88

https://doi.org/10.6315/2010.38(2)02

摘要

Objective: Patients commonly have impaired arm trunk coordination following a stroke. The trunk compensation often used by stroke patients may hinder recovery of the affected arm. Given that the extent to which constraint-induced therapy (CIT) affects arm-trunk coordination has not been investigated previously, this study examines how distributed CIT (dCIT) affects arm trunk coordination and trunk compensation strategy, as well as functional performance and quality of life.
Materials and Methods: Sixteen participants (at least 6 months post-onset) after stroke were randomly assigned to either the dCIT group which received training 2 hours daily for 3 weeks, with the unaffected arm restrained 6 hours daily or the control group which received traditional rehabilitation for equivalent intensity and duration). Kinematic analysis was performed to investigate the arm-trunk coordination during unilateral and bilateral tasks. Additionally, functional ability and quality of life of the participants were assessed by using two clinical measures (Functional Independent Measure, FIM and Stroke Specific Quality of Life Scale, SSQOL). All outcomes were measured at the beginning and end of the 3-week intervention.
Results: The two groups did not differ at baseline (p＞0.05). Experimental results indicated that the two groups statistically differed during the unilateral tasks on elbow extension angular change (p=0.030), trunk flexion angular change (p=0.045), elbow extension & trunk flexion correlation (p=0.020), and early part, terminal part, and total of the trunk contribution slope (p＜0.05). The two groups also statistically differed in elbow extension angular change (p=0.017), trunk-arm delay (p=0.030), and the total trunk contribution slope (p=0.033) during bilateral tasks. Statistically different on transfer domains of FIM (p=0.046) and family role domain of SSQOL (p=0.013) were noted as well.
Conclusion: After 3 weeks of dCIT, the participants reduced trunk compensation more than the control group did in terms of better elbow joint control during both unilateral or bilateral tasks, thus demonstrating that dCIT elicits better arm trunk coordination and motor control. Participants in the dCIT group also performed better than the control group in terms of functional ability and quality of life.

關鍵字

侷限誘發療法 ； 運動學分析 ； 手臂－軀幹協調性 ； 中風

並列摘要

Objective: Patients commonly have impaired arm trunk coordination following a stroke. The trunk compensation often used by stroke patients may hinder recovery of the affected arm. Given that the extent to which constraint-induced therapy (CIT) affects arm-trunk coordination has not been investigated previously, this study examines how distributed CIT (dCIT) affects arm trunk coordination and trunk compensation strategy, as well as functional performance and quality of life.
Materials and Methods: Sixteen participants (at least 6 months post-onset) after stroke were randomly assigned to either the dCIT group which received training 2 hours daily for 3 weeks, with the unaffected arm restrained 6 hours daily or the control group which received traditional rehabilitation for equivalent intensity and duration). Kinematic analysis was performed to investigate the arm-trunk coordination during unilateral and bilateral tasks. Additionally, functional ability and quality of life of the participants were assessed by using two clinical measures (Functional Independent Measure, FIM and Stroke Specific Quality of Life Scale, SSQOL). All outcomes were measured at the beginning and end of the 3-week intervention.
Results: The two groups did not differ at baseline (p＞0.05). Experimental results indicated that the two groups statistically differed during the unilateral tasks on elbow extension angular change (p=0.030), trunk flexion angular change (p=0.045), elbow extension & trunk flexion correlation (p=0.020), and early part, terminal part, and total of the trunk contribution slope (p＜0.05). The two groups also statistically differed in elbow extension angular change (p=0.017), trunk-arm delay (p=0.030), and the total trunk contribution slope (p=0.033) during bilateral tasks. Statistically different on transfer domains of FIM (p=0.046) and family role domain of SSQOL (p=0.013) were noted as well.
Conclusion: After 3 weeks of dCIT, the participants reduced trunk compensation more than the control group did in terms of better elbow joint control during both unilateral or bilateral tasks, thus demonstrating that dCIT elicits better arm trunk coordination and motor control. Participants in the dCIT group also performed better than the control group in terms of functional ability and quality of life.

並列關鍵字

constraint-induced therapy ； kinematics analysis ； arm-trunk coordination ； stroke